Risk factors for surgical site infections in rectal cancer patients

Introduction. Rectal cancer surgery is associated with high rates of post-operative complications in which the most common are Surgical Site Infections (SSI). Materials and methods. Factors responsible for SSI incidence were retrospectively analysed in rectal cancer patients who had undergone surgery at a single centre for oncology between July 2012 and July 2016. The study end-point was patients’ contracting SSI. Statistical analyses were performed by the ‘Statistica 12’ package consisting of the Pearson’s Chi-squared test (χ2), the Kruskal-Wallis test and the Mann-Whitney U-test (with continuity correction). Qualitative variables were analysed using log-linear analysis. The likelihoods of SSI incidence were compared by using odds ratios within 95% confidence limits. Results. Amongst the 187 patient subjects under observation during their 30 day follow-up, 44 (23.5%) suffered from post-operative complications of which SSI were the most common at 27 (14.4%). In those patients with advanced stage IV cancer, SSI occurred 3-fold more compared to patients with lower stage cancers; respectively 27.3% vs 11.7%, p = 0.021. Multivariate analysis demonstrated that the highest SSI risk was in patients having a low-lying tumour (≤ 5 cm from the anal rim; OR 2.31 (95% CI of 1.15 to 4.62), p = 0.019 and those patients who had undergone Hartmann’s procedure; OR 1.85 (95% CI of 1.04 to 3.31), p = 0.038. Conclusions. Surgical site infections in rectal cancer patients undergoing surgery occur significantly more in those at advanced stage IV rectal cancer where the tumour is low-lying (0–5 cm from the anal rim) and after having undergone the Hartmann’s procedure

The ‘dissonant’ heritage of Nowa Huta’s shelters: Between education and entertainment

The following article attempts to show how the heritage space of Nowa Huta undergoes gradual transformation under the influence of tourism. An example, which is going to be examined, is a new tourist route presenting the heritage of shelters at Nowa Huta. The context for this discussion is the concept of edutainment, which is a form of education through entertainment. It will be discussed that the inclusion of entertainment elements in the process of dissonant heritage interpretation, is a solution that facilitates noticing ambivalences resulting from the complex nature of the past, and thus contributes to more profound understanding and opens a space for the acceptance of the heritage

Schrony w Nowej Hucie jako kłopotliwe dziedzictwo: pomiędzy edukacją a rozrywką

W artykule podjęto próbę ukazania, w jaki sposób przestrzeń dziedzictwa Nowej Huty ulega stopniowej transformacji pod wpływem ruchu turystycznego. Przykładem, który zostanie przeanalizowany, jest projekt nowej trasy turystycznej, prezentującej schrony w Nowej Hucie. Kontekstem do rozważań będzie koncepcja edutainment, czyli forma edukacji poprzez rozrywkę. Rozważania będą oparte na tezie, że włączanie elementów rozrywki w proces interpretacji kłopotliwego dziedzictwa stanowi rozwiązanie, które ułatwia dostrzeżenie ambiwalencji wynikających ze złożonej przeszłości i tym samym przyczynia się do bardziej pogłębionego rozumienia, a w konsekwencji także do akceptacji dziedzictwa

Selected nutritional risk parameters in patients with laryngeal cancer — a comparison with other patients hospitalized in a Department of Laryngology and patients with colorectal cancer

Background: It is assumed that neoplasm greater in size may affect a patients’ nutritional status and prognosisstronger than smaller one. The aim of this study was to compare the nutritional status and prognosisof patients with laryngeal cancer (LC), recognized as tumour smaller in size, and patients with colorectalcancer (CRC) who were hospitalized in our hospital during the one year period. Methods: The retrospective review of medical documentation of all 1,134 patients hospitalized in a Departmentof Otolaryngology. Results: The laryngeal tumour was smaller than colorectal. Nutritional risk concerned 9% of patients withLC, was greater than in patients with other laryngeal disorders (1.4%), and lower than in patients withCRC (37%). A Nutritional Risk Screening (NRS) 2002 score ≥ 3 was the only significant factor influencingthe risk of in-hospital all-cause mortality, 14- and 30-day readmissions in patients with LC, and the risk of14-day rehospitalization in patients with CRC. Conclusions: Risk of malnutrition in patients with LC was lower than in counterparts with CRC, and concern9% and 37% of patients, respectively. Nutritional risk diagnosed in patients with LC had a strongerassociation with the prevalence of the measured outcomes (in-hospital death, the risk of 14-day and30-day readmission, length of hospitalization) than in individuals with CRC

Septic state and ileus as the late complications of non-occlusive mesenteric ischemia — case report

Ostre niedokrwienie jelit jest schorzeniem względnie rzadkim, ale o bardzo poważnym rokowaniu. Może być ono spowodowane niedrożnością tętnic trzewnych, ich skurczem lub zmniejszeniem ciśnienia perfuzyjnego (tzw. NOMI, niedokrwienie nieokluzyjne) albo zakrzepicą żył trzewnych. W pracy przedstawiono przypadek pacjenta, u którego w przebiegu wstrząsu septycznego wikłającego zapalenie płuc najprawdopodobniej doszło do NOMI. Następstwem tego powikłania były nawracające stany septyczne spowodowane przez Enterococcus fecalis oraz szybko postępujące, wieloodcinkowe zwężenia jelita cienkiego prowadzące do niedrożności przewodu pokarmowego. Z jej powodu dokonano resekcji jelita cienkiego i wyłonienia ileostomii, w następstwie czego chory wymagał całkowitego, a potem częściowego żywienia pozajelitowego. W omawianym przypadku, mimo wczesnego podejrzenia klinicznego, że powodem zaburzeń pasażu jelitowego oraz nawracających stanów septycznych powodowanych paciorkowcami „jelitowymi” jest niedokrwienne uszkodzenie jelita powstałe w przebiegu wstrząsu septycznego, nie udało się udokumentować tego powikłania na tyle, by wdrożyć leczenie chirurgiczne zanim doszło do rozsiewu ognisk zakażenia. Stały się one najbardziej prawdopodobnym źródłem późniejszego zakażenia cewnika do żywienia pozajelitowego i posocznicy, które wraz z udarem przyczyniły się ostatecznie do zgonu chorego.Acute bowel ischemia is a relatively rare condition, but with a very serious prognosis. It may be caused by obstruction of the visceral artery, arterial spasm or reduction in visceral perfusion (NOMI, non-occlusive ischemia), or visceral venous thrombosis. In this paper we present a case of a male patient, in whom during septic shock in the course of pneumonia, probably NOMI occurred. The consequence of this complication were recurrent febrile states and rapidly progressing, multisegmental narrowing of the small bowel resulting in the ileus within four months. It required small bowel resection, ileostomia and parenteral nutrition. We failed to sufficiently document the source of these late NOMI complications and introduce the surgery before dissemination of infection of faecal streptococci. These infection focuses were likely the source of nutritional catheter contagion and recurrent septic conditions, which together with stroke, finally caused patient’s death

Variant alleles of the CYP1B1 gene are associated with colorectal cancer susceptibility

<p>Abstract</p> <p>Background</p> <p>CYP1B1 is a P450 enzyme which is involved in the activation of pro-carcinogens to carcinogens as well as sex hormone metabolism. Because differences in the activity of the enzyme have been correlated with variant alleles of single nucleotide polymorphisms (SNPs), it represents an attractive candidate gene for studies into colorectal cancer susceptibility.</p> <p>Methods</p> <p>We genotyped 597 cancer patients and 597controls for three CYP1B1 SNPs, which have previously been shown to be associated with altered enzymatic activity. Using the three SNPs, eight different haplotypes were constructed. The haplotype frequencies were estimated in cases and controls and then compared. The odds ratio for each tumour type, associated with each haplotype was estimated, with reference to the most common haplotype observed in the controls.</p> <p>Results</p> <p>The three SNPs rs10012, rs1056827 and rs1056836 alone did not provide any significant evidence of association with colorectal cancer risk. Haplotypes of rs1056827 and rs10012 or rs1056827 and rs1056836 revealed an association with colorectal cancer which was significantly stronger in the homozygous carriers. One haplotype was under represented in the colorectal cancer patient group compared to the control population suggesting a protective effect.</p> <p>Conclusion</p> <p>Genetic variants within the CYP1B1 that are associated with altered function appear to influence susceptibility to a colorectal cancer in Poland. Three haplotypes were associated with altered cancer risk; one conferred protection and two were associated with an increased risk of disease. These observations should be confirmed in other populations.</p